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September 2005 (Vol 27, No 9)

Letters (September 2005)

Clinical Snapshots

I really enjoy Clinical Snapshots: They are usually a very useful, stimulating way of reviewing topics. To this purpose they have to be precise and clear. I am afraid to say that Clinical Snapshot #1 in the May 2005 issue (pp 323 and 338) is lacking in both respects.

First of all, the radiograph is very unclear and difficult to interpret. Even if it is obvious that the ureter is dilated, it is not possible to get a complete picture to rule out conditions that need to be differentiated, such as stenotic/atretic or obstructed ureters or concurrent problems that can influence the prognosis and/or modify the treatment (e.g., hydro­nephrosis, pyelonephritis), all of which are important for planning the case.

Also, I would not have included "intramural ureter with no distal opening" in the morphologic variations. As reported in the literature, "because of limited direct viewing of the distal portion of the urethra during surgery, the terminal opening of an ectopic ureter is not commonly identified at surgery."1,2

Finally, no mention is made of transurethral cystoscopy for assessing the condition. Excretory urography has been the gold standard until recently and is still the most widespread method of evaluating ectopic ureters, but it has its drawbacks, including the presence of superimposing structures and retrograde filling of the bladder from displaced ureters. Therefore, adjunctive diagnostic modalities such as ultrasonography, contrast-enhanced computed tomography, and cystoscopy should be considered.3 In particular, transurethral cystoscopy, because of its ability to identify the morphologic abnormality and the high correlation between its results and surgical findings, provides a more accurate method of assessing ureteral ectopia in female dogs, in which this condition is diagnosed with significantly greater frequency.4

Rosa Angela Ragni, DVM, DCAM, MRCVSBristol, UK

Behavior

Mr. Roy S. Spitalnik's letter to the editor (July 2005, p. 493) was certainly interesting. Although Mr. Spitalnik may have been disappointed with Dr. Beth Thompson's column, I can guarantee you that I was much more disappointed with Mr. Spitalnik's letter. Perhaps, at best, it is a matter of misinformation, but there are several points in Mr. Spitalnik's letter that I would like to address.

First, for Mr. Spitalnik to make a blanket statement about the lack of behavior training of veterinarians based on the six that he has worked with (roughly 0.02% of us here in America) is nothing more than an uninformed opinion—and from someone self-proclaiming his limited credentials.

Second, the statement that behaviorists and trainers are qualified to educate clients while veterinarians are not is patently absurd and insultingly arrogant. I could easily name six behaviorists/trainers in my area who are not qualified to teach a dog to sit, let alone handle aggression cases, so by using Mr. Spitalnik's criteria, apparently nobody is qualified to treat aggression.

Third, Mr. Spitalnik seems to be woefully ignorant about veterinary education and training, as evidenced by his statements, "Veterinarians do not study behavior in school...Aggression is far too complex for veterinarians to manage correctly...Veterinarians and veterinary students are not familiar with the difference between genetic versus learned aggression, the history of breeds and aggression, drive-motivated aggression, etc.," all of which are ridiculously untrue.

Fourth, although Mr. Spitalnik seems to want to keep "professionals" from practicing where they are "not qualified," as evidenced by his statement, "I don't try to give my behavior or training clients veterinary advice or services because I am not qualified," he certainly seems willing to lecture us on pathology: "But stress is the number-one cause of disease because it weakens the immune system..." And Mr. Spitalnik's training and credentials in diseases and pathology in animals are...?

Perhaps a more truthful assessment of Mr. Spitalnik's assertions is that there are some veterinarians who do not possess the knowledge, experience, desire, or time (all of which are important) to properly manage aggression cases and that such cases are probably best referred to a qualified animal behaviorist or trainer. By the same token, a qualified animal behaviorist or trainer must have the aforementioned attributes to properly address concerns of aggression and must be willing to work with the referring veterinarian.

Yes, there are many cases that veterinarians would be better off referring for aggression management; ­however, in many cases, there are not qualified behaviorists and/or trainers in the area and we have to do the best we can. Certainly, an ideal situation would be for veterinarians to refer cases that, for whatever reason, they are unwilling or unable to properly deal with to a qualified behaviorist/trainer with whom they have a relationship of mutual respect and cooperation. This would be best for our clients and patients, who are our primary concern.

Lack of experience, knowledge, or confidence need not inhibit veterinarians who wish to better handle aggression cases, as we have many CE opportunities available to us.

However disappointing Mr. Spitalnik's arrogance and ignorance may be, we need to keep in mind that there are many fine behaviorists and trainers out there with whom we can cultivate a relationship as an extension of our practices.

John S. Parker, DVMBriarpointe Veterinary ClinicNovi, Michigan

I had to respond to Roy Spitalnik's remarks in his letter about behavior training. In it, he states that veterinarians do not study behavior in school. Well, I graduated from North Carolina State University College of Veterinary Medicine in 1990, and I had a semester on behavior. We also had a small animal clinical rotation in behavior that was so popular it was hard to get into. I am not a veterinary behaviorist, but I have attended many continuing education seminars on the subject, and they are generally well attended.

When clients come in to discuss a behavior issue, I spend time with them to make sure they understand the problem and the work involved in solving it. I also routinely refer them to a trainer for private training sessions. In particular, I, like many veterinarians, deal with aggression issues. I discuss the causes and types of aggression with clients because it is important for them to understand that different types of aggression need to be handled with different methods. I feel comfortable advising clients and pointing them in the right direction.

What most veterinarians lack is the time it takes to do the actual hands-on work with owners and dogs in repeated training sessions. This is where we rely on trainers and behaviorists, and we should work together—after all, clients often seek the advice of their veterinarian first, and in some cases, pharmacologic intervention is also needed.

Bethany Summers, DVM Blairstown Animal HospitalBlairstown, New Jersey

Expanding on the Oath

As a veterinarian who was involved in food animal practice, military veterinary public health, and companion animal practice near the end of the 20th century, I became concerned that the veterinary profession should enter the present century with more of an international or global movement toward the protection and care of all animals. We are certainly involved in food animal medicine, wildlife medicine, zoo animal medicine, laboratory animal medicine, etc. I suggested to the AVMA that the veterinary oath be modified from limited conservation of livestock resources to express conservation of animal resources, which the AVMA approved. It certainly indicates that the AVMA is a responsive, dynamic, and forward-moving organization that we can be proud to be a part of.

I certainly feel that the oath embodies what we are all about, and although it may not guarantee morality, it certainly helps individuals strive for it. It also provides a sense of mission and goals for the profession. The oath is sort of the "glue" that holds the veterinary profession together.

Having said that, the bottom line is it has been great to be part of one of the world's greatest professions.